- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,371.00 / $14,879.80 / $20,047.50
| Facility | | $9,371.00 | $14,879.80 | $20,047.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,002.50 / $12,330.38 / $21,038.47
| Facility | | $11,002.50 | $12,330.38 | $21,038.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,395.43 / $13,585.48 / $20,380.80
| Facility | | $8,395.43 | $13,585.48 | $20,380.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,720.01 / $12,120.99 / $20,206.08
| Facility | | $6,720.01 | $12,120.99 | $20,206.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,264.62 / $12,337.50 / $17,846.71
| Facility | | $7,264.62 | $12,337.50 | $17,846.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,063.06 / $15,538.81 / $21,559.91
| Facility | | $8,063.06 | $15,538.81 | $21,559.91 |